چکیده انگلیسی

The experience of depression is diverse based on social locations and context. A sociological perspective building on masculinity, illness work, and the self provides a useful theoretical framework to understand how older men negotiate emotional suffering. This article examines older men's accounts of their depression experience from a social constructionist approach. This analysis is based on data from 77 in-depth interviews with depressed older men who participated in a larger mixed-method study, the Men's Health and Aging Study (MeHAS). We show how older men construct depression accounts in which they integrate biological and social factors associated with feeling a loss of control. This is experienced as a shamed masculine self given their inability to perform manhood acts, which leads them to severe social bonds. Men's accounts also shed light on how they resist the shaming of the masculine self by deploying two primary strategies: acting overtly masculine through aggressive behavior and by retracting from social interactions that may lead to feelings of shame. These strategies appear futile and they are only partially able to embrace alternative masculine values in line with roles as grandparents and older, wiser men. Depression in older men is characterized by an ongoing negotiation of limited statuses and roles given dominant conceptions of masculinity.

مقدمه انگلیسی

We had been driving through the countryside for a while on a road stretching through the distance; a long gray tape woven between neatly rowed fields of almond trees, grape vines, lettuce, and other greens. We met a group of houses set at the edge of town and approached Mr. Capelli's (66 years old) house—a small humble track home bordering railroad tracks with construction fencing surrounding it. As we walked up to his porch, he shyly opened the door as if afraid or uninterested (I could not tell). “I'm sorry but I have tried to clean up but there's too much stuff” he apologized as he removed clothes, books, food wrappers, medications, and a beer can. A strong, somewhat unpleasant smell scented the room as we sat down on the couch. The rambling of a train startled me. It was so loud I thought it would rip through the house which gradually stopped shaking as the train passed by, its sound dissipating in the distance.
We talked with Mr. Capelli for nearly three hours during which he hardly made eye contact but often cried (at times inconsolably, at other times struggling to restrain himself). He answered our questions about his childhood, work, family, physical and mental health, and relationship with doctors, retirement and what the future held for him. His answers conveyed a profound suffering; his life had never been good but it had turned out worse than he expected. In his later years, he became sicker, stopped working, lost his wife, struggled to pay bills, and had a cursory relationship with his sons. He often sought medical help for his various ills, including depression for which he was taking medications that did not seem to help. “It's just horrible, horrible” he said, “I don't wish this on anybody … everything is piling up on me, and there's nothing I can do about it, except for just sit there, and just say, ‘okay, you want it, come and get it.’ I don't want any of it. I just want to get it over with because I'm tired of fighting it.” How do we make sense of Mr. Capelli's despair? Why do Mr. Capelli and other older men like him view the world in this way? How does he deal with this emotional distress and what does that mean to a man who is now older? This article examines the illness experience of older men with depression in the context of masculinity and aging, as it implicates what sociologists call the “self.”

نتیجه گیری انگلیسی

8. Conclusion
The experience of depression was layered as men wove into their accounts a complex narrative of the trajectories of their emotional suffering and deteriorating manhood. Our findings contextualize older men's depression illness experience in relation to this shamed masculine self; a self based upon notions of masculinity that emphasized being productive (typically through work) and being in control (of themselves and their world). Masculine expectations around material accomplishments and social status meant remaining productive and independent. Men's depression experience extended beyond an isolated pathology into a complex and dynamic social disruption of the gendered—masculine—self that was signaled to and recognized by others as a receding ability to perform credible manhood acts. The line between volition—the ability to enact one's intents purposively—and not having control over one's life was definitive of men's depression experience. Thus our analysis suggests that masculinity and aging intersect powerfully in how men deal with the confounding impact of physical, biographical, and social forces that shape their sense of self (for a related review of the literature on depressed individuals' ability to self-manage and maintain quality of life, see Houle et al., 2013). In the context of depression and aging, the loss of productivity crippled their ability to perform expected manhood acts convincingly. These are narratives of men who seem to have lost control of their bodies, their emotions, and their place in the social world.
For these older men, depression was something they had to fix in order to rescue the only self they and their world valued. Grasping to their role as workers, seeking isolation to avoid ill-fated interactions, and acting in overtly aggressive ways to demonstrate their control, all failed them. Attempts to reframe the depression experience were relinquished as men objectified depression as an autonomous entity above and beyond their control; as if depression existed outside of them perhaps similarly to how physical disease is believed to attack the body but is not intrinsically part of it. This led men to a stalemate where resignation or acceptance of their condition allowed some reflection on their life course. What is clear in the men's narratives is that none of them seemed (yet) to have a convincing alternative to the masculine self easily at hand, a self that might have meaningfully substituted for the one they were losing. The narrowness of the self inflicted as much pain now as the status it once conferred. With nowhere else to turn, these men could only turn inwards to discover a shrinking set of symbolic resources for dealing with their condition. Many questions remain as to what, if any, this resolution will look like as men move forward toward the eclipse of their lives (for a more optimistic account of the interaction between aging and depression among men, see Roy et al., 2014).
Our analysis also raises questions regarding the role of ethnicity in relation to masculinity, depression, and the self. As our findings show, there are significant overarching similarities between the white and Mexican-heritage men. While our data do not clearly support ethnic differences, consistent with other literature we speculate that ethnicity may still influence the experience of depression vis-à-vis the masculine self. For instance, we found some evidence suggesting that the Mexican-heritage men spoke of threats to the masculine self in terms of productivity more closely tied to the economic welfare of their family, whereas the white-non-Hispanic men did so in more individualistic terms such as their inability to live their dreamed and longed “golden years.” Future analyses may focus on how these different orientations imbued with ethnic undertones inform the reworking of an older self.
Our study may involve a degree of researcher bias that does not necessarily refute our findings and still points to important lessons and future research. First, most interviews were conducted by a (younger) woman interviewer and this may have influenced how (older) men responded to inquiry about their depression experience. It is possible that these men were more comfortable expressing their distress to a non-familial woman associated with a research institute than they might have been with a male interviewer precisely because they did not fear, nor were they defensive about, not fulfilling their traditional male role (a feeling which wives—who rely on that role—or other men—who currently fill that role—might evoke in them). Indeed, because the interviewer was non-threatening to the self that was receding from these men, their accounts convey their suffering in ways that more aptly express their sadness. Second, our sample size, while adequate for a qualitative study, does not allow for definitive generalizations to a larger group of older men. Further, the Mexican-heritage sample was not diverse in terms of socio-demographics factors (the majority were selected from a rural, poor, farm labor region), which limits any analysis of intra-group differences based on degree of social incorporation (for a related analysis of rural older men, see Cambell et al., 2006, Garnham and Bryant, 2014 and Roy et al., 2014). Another important limitation relates to analyzing translated material. While our translations were performed by fully bilingual non-U.S. born Latinos, translations are always subject to individual and socio-cultural idiosyncrasies, especially given the heterogeneity among Latinos.
Is it possible that older men with depression who have more successfully reformulated a masculine self might better negotiate their suffering and maintain improved quality of life? How would new selves help these men? What would it do for them to rearticulate their roles as husbands, partners, fathers, grandfathers, and friends? Though it would not eliminate the physical characteristics of depression, an alternative self might help them insofar as they would develop relationships of support, relationships which validate them as men. Encouraging depressed men adopt this narrative could help “cut the edge” of their depression and provide them with the symbolic resources to “fight the good fight” that our interviews found them to be losing. Health care practitioners as well as family and friends may find that focusing their efforts on establishing this counter-narrative renders more benefits to all involved. It is the least these men deserve.